JBJS | Medicare Physician Reimbursement: Past, Present, and Future

The Journal of Bone & Joint Surgery, Volume 89, Issue 11

The Orthopaedic Forum | November 01, 2007

Medicare Physician Reimbursement: Past, Present, and Future

Sanaz Hariri, MD¹; Kevin J. Bozic, MD, MBA²; Carlos Lavernia, MD³; Ann Prestipino, MPH¹; Harry E. Rubash, MD¹

¹ Department of Orthopaedic Surgery (S.H. and H.E.R.) and Surgical and Anesthesia Services and Clinical Business Development (A.P.), Massachusetts General Hospital, 55 Fruit Street, YCOC, Suite 3700, Boston, MA 02114-2696. E-mail address for S. Hariri: shariri@partners.org. E-mail address for A. Prestipino: aprestipino@partners.org. E-mail address for H.E. Rubash: hrubash@partners.org
² Department of Orthopaedic Surgery, University of California at San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728. E-mail address: bozick@orthosurg.ucsf.edu
³ Orthopaedic Institute at Mercy Hospital, 3659 South Miami Avenue, Suite 4008, Miami, FL 33133. E-mail address: CLavernia@mercymiami.org

The Journal of Bone & Joint Surgery. 2007; 89:2536-2546 doi:10.2106/JBJS.F.00697

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Recent proposals in the United States to cut Medicare physician-reimbursement rates for certain orthopaedic procedures, particularly in the field of hip and knee arthroplasty, have heightened the general orthopaedic community's interest in Medicare physician-reimbursement policy.Familiarizing oneself with Medicare physician-reimbursement policies in particular is important as most private and public insurers base their payments on Medicare fee schedules and regulations. The 2004 American Academy of Orthopaedic Surgeons (AAOS) Physician Census revealed that >90% of orthopaedists in private practice identified insurance or Medicare and Medicaid reimbursement levels and increasing practice expenses as major concerns1. Medicare and Medicaid accounted for an average of 33% of an orthopaedist's practice in 2006, having risen steadily from 26% in 19882.

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Topics

medicare ; physician payment ; medical coding ; relative value scales ; growth rate ; reimbursement mechanisms ; budgets ; health care financing administration

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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